General Tips on Bowel Training
Moving the bowels on the toilet sometimes happens during toilet training for urine. If this does not happen, start on the bowel training program we are going to describe. We suggest waiting until your child is urine trained or nearly so, and at least schedule-trained, before beginning with bowel training.
We suggest waiting until your child is urine trained, or nearly so, and at least schedule-trained, before beginning with bowel training.
Like urine training, bowel training will require extra time and attention. However, it does not usually require as much time as urine training. This is because most children move their bowels only once or twice each day. Once your child has had a good-sized bowel movement (BM), whether on or off of the toilet, you will not need to be very watchful for the rest of that day. There are exceptions to this. If, for example, your child has a history of constipation, she may have many small bowel movements during the day. We will talk more about this shortly.
Getting Ready
Before you get started, make sure the bathroom is a very inviting place to be. This is like what you did with urine training. Put some of your child’s favorite books and toys in the bathroom. For example, you could place a suction-cup basketball hoop on the wall and buy some small balls that your child can throw through the hoop. You could put a small TV, tablet, or cell phone in the bathroom. These should be available only when your child is sitting on the toilet. This will make her more willing to be on the toilet.
Set aside a Special Reward JUST for BM’s on the Toilet
Set aside one very favorite reinforcer to be used only as a reinforcer for bowel movements in the toilet. Bowel training will be easier if the reinforcer for having a “BM” on the toilet is very powerful. It should be strong enough to compete with any anxiety your child might have about having a BM on the toilet. For example, if you are using very favorite food treats use a large enough portion to be a really powerful reinforcer. And pair it with praise, tickles, hugs and kisses. In other words, don’t skimp.
Though we usually suggest using only very small treats, like one skittle, or one M&M, or a small piece of a cookie, bowel training is different. You need the reward to be really powerful. Remember, you will only need to reinforce bowel movements once or twice a day, and the need to reinforce every bowel movement is only temporary.
In urine training, we’ve suggested using small treats, like one skittle or a small piece of a cookie. Remember that your child will need to urinate several times each day. You don’t want to overdo the sweet or salty treats. Bowel training is different. You need the reward to be really powerful. Most children have only one or possibly two bowel movements each day. So you could give your child a whole snack-size bag of skittles (or about 12 skittles) for having a BM on the toilet. Throw a party! Remember, this is temporary. Once the toilet training is well established, treats will be faded out over time. Then the skill of having bowel movements in the toilet is maintained with praise alone.
Increase Your Child’s Intake of Dietary Fiber
It is recommended that you give your child 3 meals and an average of 2 large snacks each day of training. Keep smaller snacks to a minimum during this time. You want your child to drink plenty of liquids and for the foods she eats to contain plenty of fiber. Good sources of fiber are the skins of fruits and vegetables, whole grains, nuts, and seeds. Some specific high-fiber foods are: avocados, peas, berries, popcorn, whole-grain pasta, grapes, apples and pears with the skin left on, oatmeal, brown rice, beans (black beans, baked beans, split peas, and lentils), artichokes, broccoli, and corn. When you’re buying bread, cereal or other packaged foods, look at the nutrition panel on the label and pick the type that has the most fiber.
Dealing with Constipation
Does your child tend to be constipated? If she moves her bowels less than 4-5 times a week, or her bowel movements look hard and dry, your child may be constipated. In this case, it can be painful to have a bowel movement. This may lead your child to try to hold it in. Holding it in can result in small amounts of BM leaking out and soiling the underwear or diaper. If you think that your child may be constipated, please talk to your child’s doctor before you start bowel training. If your child has been constipated for a while, she may need to have a good clean-out before you get started. Your doctor can tell you how to do this safely.
If you think your child may be constipated, visit the Autism Speaks website and review their “Tool-kit” section called “Managing Constipation.” It’s also a good idea to ask your pediatrician before you start with bowel training about specific high fiber foods. Your pediatrician may also recommend a bulking agent and/or stool softener. If possible, you will want your child to have a regular bowel movement each day for several days in a row before starting bowel training. It’s a good idea to note the time of day that she moves her bowels. Often, children have a certain time of day when they are most likely to have a BM. If so, make sure that you plan a scheduled sitting for that time of day. We’ll talk more about this shortly.